Skip to main content

Advertisement

SpringerLink
Log in

Long-Term Outcomes and Lymph Node Metastasis in Patients Receiving Radical Surgery for Pathological T1 Lower Rectal Cancer

  • Original Scientific Report (including Papers Presented at Surgical Conferences)
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Few reports have evaluated the long-term outcomes of pathological T1 (pT1) lower rectal cancer (LRC), perhaps because pT1 LRC is classified as TNM stage I if lymph node metastasis (LNM) is absent and stage IIIA if LNM is present. Moreover, it is difficult to diagnose regional LNM preoperatively. This study aimed to clarify the long-term outcomes of radical surgery for pT1 LRC and risk factor(s) for LNM. Additionally, we examined whether preoperative computed tomography (CT) and magnetic resonance imaging (MRI) findings were predictive of LNM in pT1 LRC.

Methods

This was a retrospective analysis of the clinical characteristics, short-term operative outcomes, and long-term survival rates of 155 patients who received radical surgery and were diagnosed with pT1 LRC at our hospital between January 1993 and February 2017.

Results

Among patients with pT1 LRC, 5-year recurrence-free and overall survival rates were 94.0% and 95.8%, respectively. LNM status was not associated with statistically significant differences in recurrence-free or overall survival. Even in patients with LNM, the recurrence rate was only 9%. Among patients who lacked visible mesorectal lymph nodes on preoperative CT and MRI, LNM rates were 3.5% and 4.3%, respectively.

Conclusion

The long-term outcomes after radical surgery for pT1 LRC are satisfactory or good, regardless of the presence or absence of LNM. In patients with pT1 LRC, the absence of visible mesorectal lymph nodes on preoperative CT and MRI is associated with a reduced likelihood of LNM and has a high negative predictive value for LNM.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Matsuda T, Fujii T, Saito Y et al (2008) Efficacy of the invasive/non-invasive pattern by magnifying chromoendoscopy to estimate the depth of invasion of early colorectal neoplasms. Am J Gastroenterol 103:2700–2706

    Article  PubMed  Google Scholar 

  2. National Comprehensive Cancer Network. Rectal cancer. http://www.nccn.org/professionals/physician_gls/pdf/rectal.pdf. Accessed 13 April 2015

  3. Filippone A, Ambrosini R, Fuschi M et al (2004) Preoperative T and N staging of colorectal cancer: accuracy of contrast-enhanced multi-detector row CT colonography—initial experience. Radiology 231(1):83–90

    Article  PubMed  Google Scholar 

  4. Kunawudhi A, Sereeborwornthanasak K, Promteangtrong C et al (2016) Value of FDG PET/contrast-enhanced CT in initial staging of colorectal cancer—comparison with contrast-enhanced CT. Asian Pac J Cancer Prev 17(8):4071–4075

    PubMed  Google Scholar 

  5. Dighe S, Purkayastha S, Swift I et al (2010) Diagnostic precision of CT in local staging of colon cancers: a meta-analysis. Clin Radiol 65(9):708–719

    Article  CAS  PubMed  Google Scholar 

  6. Al-Sukhni E, Milot L, Fruitman M et al (2012) Diagnostic accuracy of MRI for assessment of T category, lymph node metastases, and circumferential resection margin involvement in patients with rectal cancer: a systematic review and meta-analysis. Ann Surg Oncol 19(7):2212–2223

    Article  PubMed  Google Scholar 

  7. Akasu T, Iinuma G, Takawa M et al (2009) Accuracy of high-resolution magnetic resonance imaging in preoperative staging of rectal cancer. Ann Surg Oncol 16(10):2787–2794

    Article  PubMed  Google Scholar 

  8. Hager T, Gall FP, Hermanek P (1983) Local excision of cancer of the rectum. Dis Colon Rectum 26:149–151

    Article  CAS  PubMed  Google Scholar 

  9. Stearns MW Jr, Sternberg SS, DeCosse JJ (1984) Treatment alternatives: localized rectal cancer. Cancer 54(11 suppl):2691–2694

    Article  PubMed  Google Scholar 

  10. Whiteway J, Nicholls RJ, Morson BC (1985) The role of surgical local excision in the treatment of rectal cancer. Br J Surg 72:694–697

    Article  CAS  PubMed  Google Scholar 

  11. Biggers OR, Beart RW Jr, Ilstrup DM (1986) Local excision of rectal cancer. Dis Colon Rectum 29:374–377

    Article  CAS  PubMed  Google Scholar 

  12. Billingham RP (1992) Conservative treatment of rectal cancer: extending the indications. Cancer 70(5):1355–1363

    Article  CAS  PubMed  Google Scholar 

  13. Coco C, Magistrelli P, Granone P et al (1992) Conservative surgery for early cancer of the distal rectum. Dis Colon Rectum 35:131–136

    Article  CAS  PubMed  Google Scholar 

  14. Heimann TM, Oh C, Steinhagen RM et al (1992) Surgical treatment of tumors of the distal rectum with sphincter preservation. Ann Surg 216:432–436

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Graham RA, Atkins MB, Karp DD et al (1994) Local excision of rectal carcinoma: early results with combined chemoradiation therapy using 5-fluorouracil and leucovorin. Dis Colon Rectum 37:308–312

    Article  CAS  PubMed  Google Scholar 

  16. Frazee RC, Patel R, Belew M et al (1995) Transanal excision of rectal carcinoma. Am Surg 61:71–77

    Google Scholar 

  17. Bleday R (1997) Local excision of rectal cancer. World J Surg 21:706–714. https://doi.org/10.1016/j.suc.2017.01.007

    Article  CAS  PubMed  Google Scholar 

  18. Taylor RH, Hay JH, Larsson SN (1998) Transanal local excision of selected low rectal cancers. Am J Surg 175:360–363

    Article  CAS  PubMed  Google Scholar 

  19. Chakravarti A, Compton CC, Shellito PC et al (1999) Long-term follow-up of patients with rectal cancer managed by local excision with and without adjuvant irradiation. Ann Surg 230:49–54

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Graham RA, Hackford AW, Wazer DE (1999) Local excision of rectal carcinoma: a safe alternative for more advanced tumors? J Surg Oncol 70:235–238

    Article  CAS  PubMed  Google Scholar 

  21. Ishizaki Y, Takeda Y, Miyahara T et al (1999) Evaluation of local excision for sessile-type lower rectal tumors. Hepatogastroenterology 46:2329–2332

    CAS  PubMed  Google Scholar 

  22. Steele GD Jr, Herndon JE, Bleday R et al (1999) Sphincter-sparing treatment for distal rectal adenocarcinoma. Ann Surg Oncol 6:433–441

    Article  PubMed  Google Scholar 

  23. Varma MG, Rogers SJ, Schrock TR et al (1999) Local excision of rectal carcinoma. Arch Surg 134:863–867

    Article  CAS  PubMed  Google Scholar 

  24. Garcia-Aguilar J, Mellgren A, Sirivongs P et al (2000) Local excision of rectal cancer without adjuvant therapy: a word of caution. Ann Surg 231:345–351

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Mellgren A, Sirivongs P, Rothenberger DA et al (2000) Is local excision adequate therapy for early rectal cancer? Dis Colon Rectum 43:1064–1071

    Article  CAS  PubMed  Google Scholar 

  26. Russell AH, Harris J, Rosenberg PJ et al (2000) Anal sphincter conservation for patients with adenocarcinoma of the distal rectum: long-term results of radiation therapy oncology group protocol 89-02. Int J Radiat Oncol Biol Phys 46:313–322

    Article  CAS  PubMed  Google Scholar 

  27. Watanabe T, Itabashi M, Shimada Y et al (2012) Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer. Int J Clin Oncol 17:1–29

    Article  PubMed  Google Scholar 

  28. Kanda Y (2013) Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 48(3):452–458

    Article  CAS  Google Scholar 

  29. Ikematsu H, Yoda Y, Matsuda T et al (2013) Long-term outcomes after resection for submucosal invasive colorectal cancers. Gastroenterology 144:551–559

    Article  PubMed  Google Scholar 

  30. Kyzer S, Bégin LR, Gordon PH et al (1992) The care of patients with colorectal polyps that contain invasive adenocarcinoma. Cancer 70:2044–2050

    Article  CAS  PubMed  Google Scholar 

  31. Minamoto T, Mai M, Ogino T et al (1993) Early invasive colorectal carcinomas metastatic to the lymph node with attention to their nonpolypoid development. Am J Gastroenterol 88:1035–1039

    CAS  PubMed  Google Scholar 

  32. Cooper HS (1983) Surgical pathology of endoscopically removed malignant polyps of the colon and rectum. Am J Surg Pathol 7:613–623

    Article  CAS  PubMed  Google Scholar 

  33. Nusko G, Mansmann U, Partzsch U et al (1997) Invasive carcinoma in colorectal adenomas: multivariate analysis of patient and adenoma characteristics. Endoscopy 29:626–631

    Article  CAS  PubMed  Google Scholar 

  34. Nerad E, Lahaye MJ, Maas M et al (2016) Diagnostic accuracy of CT for local staging of colon cancer: a systematic review and meta-analysis. AJR Am J Roentgenol 207(5):984–995

    Article  Google Scholar 

  35. Keeney G, Jafri SZ, Mezwa DG (1989) Computed tomographic evaluation and staging of cecal carcinoma. Gastrointest Radiol 14:65–69

    Article  CAS  PubMed  Google Scholar 

  36. Kwok H, Bisset IP, Hill GL (2000) Preoperative staging of rectal cancer. Int J Colorectal Dis 15:9–20

    Article  CAS  PubMed  Google Scholar 

  37. Brown G, Richards CJ, Bourne MW et al (2003) Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison. Radiology 227:371–377

    Article  Google Scholar 

  38. Herbertson R, Scarsbrook AF, Lee ST et al (2009) Established, emerging and future roles of PET/CT in the management of colorectal cancer. Clin Radiol 64:225–237

    Article  CAS  PubMed  Google Scholar 

  39. Chan K, Welch S, Walker-Dilks C et al (2012) Evidence-based guideline recommendations on the use of positron emission tomography imaging in colorectal cancer. Clin Oncol (R Coll Radiol) 24(4):232–249

    Article  CAS  Google Scholar 

  40. Puli SR, Reddy JB, Bechtold ML et al (2009) Accuracy of endoscopic ultrasound to diagnose nodal invasion by rectal cancers: a meta-analysis and systematic review. Ann Surg Oncol 16:1255–1265

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The study was approved by the Institutional Review Board of the National Cancer Center Hospital.

Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-City, Chiba, 277-8577, Japan

    Daichi Kitaguchi, Takeshi Sasaki, Yuji Nishizawa, Yuichiro Tsukada & Masaaki Ito

Authors
  1. Daichi Kitaguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takeshi Sasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yuji Nishizawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuichiro Tsukada
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Masaaki Ito
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Takeshi Sasaki or Masaaki Ito.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kitaguchi, D., Sasaki, T., Nishizawa, Y. et al. Long-Term Outcomes and Lymph Node Metastasis in Patients Receiving Radical Surgery for Pathological T1 Lower Rectal Cancer. World J Surg 43, 649–656 (2019). https://doi.org/10.1007/s00268-018-4824-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-018-4824-2

Search

Navigation